Provider Demographics
NPI:1831143932
Name:GIBBS, DANA RAY (CRNA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RAY
Last Name:GIBBS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 BROAD MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2478
Mailing Address - Country:US
Mailing Address - Phone:478-272-5477
Mailing Address - Fax:
Practice Address - Street 1:231 BROAD MEADOWS RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2478
Practice Address - Country:US
Practice Address - Phone:478-595-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN101512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000815306QMedicaid
GA000815306QMedicaid